Meta-analysis review links anxiety and depression to reduced cognitive flexibility and decision-making

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medRxiv Published May 19, 2026 Medically reviewed May 19, 2026 Study authors: Balcazar, J.; Albanese, B.; Rymer, T.; Davis, M.; Campos, S.; Polimerou, M.; Abel, E.; Shapley, J.; … DOI ↗ By Dr. Ji-eun Park, MD · Brain, Mind & Pain

Key Takeaway

Note that anxiety and depression are associated with reduced cognitive flexibility and decision-making.

This publication is a meta-analysis review that examines the relationship between anxiety and depression and specific cognitive domains. The scope of the review focuses on cognitive flexibility and decision-making as primary areas of interest. The authors synthesize findings indicating that anxiety and depression are associated with reduced performance in these cognitive tasks. No significant differences were observed between anxiety and depression for either decision-making or flexibility outcomes in the subgroup analysis.

The authors acknowledge that a large amount of between-subject heterogeneity was anticipated in the data. This limitation suggests caution when interpreting the pooled results across different populations. Specific effect sizes, absolute numbers, and confidence intervals were not reported in the source material. Consequently, the magnitude of the association remains qualitative rather than quantitative.

Safety data, including adverse events and tolerability, were not reported in this review. The practice relevance of these findings is not explicitly detailed by the authors. Clinicians should interpret these associations with restraint given the lack of specific numerical data and the noted heterogeneity. The review does not establish causality and relies on observational associations.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

The ability to adjust to changing environments (cognitive flexibility) and optimal decision-making are pivotal brain functions that govern successful human behavior. Anxiety and depressive disorders are strongly pervasive psychiatric conditions across the lifespan that profoundly disrupt mechanisms of attention, working memory, and decision-making. Although existing task evidence documents impaired decision-making and flexibility outcomes for both anxiety and depression, there is a growing need to systematically evaluate the role of anxiety and depression and to quantitatively compare the effects of these disorders on these domains. In the present study, we conducted a meta-analysis of anxiety and depression on decision-making and cognitive flexibility. We utilized a random-effects approach, given that a large amount of between-subject heterogeneity was anticipated. Given the scope of this meta-analysis, we used the machine learning tool asReview to more efficiently conduct a meta-analytic search. Across all outcomes, results showed anxiety and depression were associated with reduced cognitive flexibility and decision-making. These effect sizes were then tested for significance using a fixed-effects (plural) model. Subgroup analyses revealed no significant differences between anxiety and depression for either decision-making or flexibility outcomes, consistent with a transdiagnostic perspective. Results are contextualized in light of the biopsychosocial model and potential transdiagnostic factors.